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Humana Gold Plus H0028-043 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H0028-043 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus H0028-043 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H0028-043 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Texas. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H0028-043 (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Gold Plus H0028-043 (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Humana Gold Plus H0028-043 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $2.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4225.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Humana Gold Plus H0028-043 (HMO) prescription drug plan features an annual drug deductible of $615. You can save on Tier 1 preferred generic drugs, which feature no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also budget-friendly, costing a $5 copay for a 1-month supply at standard pharmacies or no copay for a 3-month supply filled via preferred mail order. For Tier 3 preferred brand drugs, you will pay a $45 copay for a 1-month supply at standard pharmacies and through preferred mail order. More expensive medications are subject to coinsurance, with Tier 4 non-preferred drugs requiring 48% coinsurance and Tier 5 specialty drugs requiring 25% coinsurance. Standard mail order options are also available across tiers, though they generally come with higher copayments.
Additional Benefits
The Humana Gold Plus H0028-043 (HMO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a low $15 copay, while inpatient hospital stays charge a $295 daily copay for the first five days and no copay for days six through 90. Emergency room visits have a $130 copay, which is waived upon admission, and urgent care visits require a $50 copay. Supplemental benefits include routine dental care with no copay up to a $3,000 annual maximum and routine vision exams and eyewear with no copay up to a $300 annual limit. Routine hearing exams and over-the-counter hearing aids are also covered with no copay, though prescription hearing aids carry copays between $199 and $499. For medical equipment and dialysis services, members can expect a 20% coinsurance with no copay.
Inpatient Hospital See details
Inpatient hospital services are covered by Humana Gold Plus H0028-043 (HMO) with no coinsurance and a copay of $295 per day for days 1 to 5, and no copay for days 6 to 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H0028-043 (HMO) covers outpatient services with no coinsurance, featuring a $0 to $275 copay for outpatient hospital services and a $295 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions have a copay of $20 to $35 with no coinsurance.
Partial Hospitalization See details
Humana Gold Plus H0028-043 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Humana Gold Plus H0028-043 (HMO) plan, featuring a $335 copay and no coinsurance for ground ambulance services, and a 20% coinsurance with no copay for air ambulance services. Prior authorization is required for all ambulance services, and routine transportation services to health-related locations are not covered.
Emergency Services See details
Humana Gold Plus H0028-043 (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are all available with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H0028-043 (HMO) features primary care physician visits with no copay and no coinsurance, and specialist visits for a $15 copay and no coinsurance. Physical and occupational therapies require a $25 copay with no coinsurance, while podiatry is not covered, and some chiropractic services are covered but routine and other chiropractic services are not.
Preventive Services See details
Humana Gold Plus H0028-043 (HMO) covers key preventive services, including annual physical exams, kidney disease education, and various screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering a memory fitness benefit with no copay, while sub-services such as health education, in-home safety assessments, and weight management are not covered.
Hearing Services See details
Hearing services are covered by Humana Gold Plus H0028-043 (HMO) with no deductibles and no coinsurance, offering routine exams and fittings at no copay and Medicare-covered exams for a $15 copay. Prescription hearing aids are partially covered with copays from $199 to $499 for up to two devices per year—excluding inner, outer, and over-the-ear types—while over-the-counter hearing aids are covered with no copay.
Vision Services See details
Vision services are partially covered by Humana Gold Plus H0028-043 (HMO) with no coinsurance and copays ranging from $0 to $15, depending on the service. While routine eye exams and eyewear are covered with no copay up to a $300 annual limit, other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H0028-043 (HMO) partially covers dental services, offering Medicare-covered dental care with a $15 copay and no coinsurance, and other covered preventive and comprehensive dental services with no copay and no coinsurance up to a $3,000 annual maximum. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Humana Gold Plus H0028-043 (HMO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Medicare Part B drugs, including chemotherapy, radiation, and insulin, require a coinsurance ranging from no coinsurance to 20%, with insulin carrying a $35 copay and other Part B drugs requiring no copay.
Dialysis Services See details
Dialysis services are covered by the Humana Gold Plus H0028-043 (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Gold Plus H0028-043 (HMO) covers durable medical equipment, prosthetics, and medical supplies with 20% coinsurance and no copay. Diabetic supplies are covered with 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay and coinsurance.
Diagnostic and Radiological Services See details
Humana Gold Plus H0028-043 (HMO) covers diagnostic and radiological services with prior authorization, featuring no copay or coinsurance for lab services, and no copay for outpatient X-rays. Diagnostic procedures have a $0 to $100 copay with no coinsurance, while therapeutic radiological services require a minimum $15 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H0028-043 (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Humana Gold Plus H0028-043 (HMO) plan with no coinsurance, though prior authorization is required. While some services are covered, specific sub-services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered and require copays ranging from $15 to $20.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H0028-043 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a daily copayment of $10 for days 1 through 20 and $218 for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Other services are partially covered by Humana Gold Plus H0028-043 (HMO), which provides acupuncture, over-the-counter items, and meal benefits with no copay and no coinsurance, while other miscellaneous services and dual-eligible SNP benefits are not covered. Prior authorization is required for the acupuncture and meal benefits, which both have specific coverage limits.
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